Create Summer 2015 by Littleton Adventist Hospital

SUMMER 2015 • Volume 3, Issue 3

Your health. Your life.

GOOD

NEWS EARLIER DETECTION OF BREAST CANCER LEADS TO GREATER SURVIVAL RATES

a n d ...

NEW SCREENING RECOMMENDATIONS Page 3

GYN CANCER WARNING SIGNS Page 6

RADIATION THERAPY COMES TO LITTLETON Page 7

IN GOOD HEALTH

Littleton Adventist Hospital brings specialized care to the people of South Denver in the complex areas of trauma, cancer, neurology, cardiology, orthopedics, women’s services, and more. We are part of Centura Health, the state’s largest health care network. The purpose of this publication is to support our mission to improve the health of the residents of our community. No information in this publication is meant as a recommendation or as a substitution for your physician’s advice. If you would like to comment or unsubscribe to this magazine, please email create@centura.org. Create is published four times annually by Littleton Adventist Hospital — Portercare Adventist Health System. Create is produced by Clementine Health Marketing. 7700 S. Broadway Littleton, CO 80122 mylittletonhospital.org

2 | SUMMER 2015 • Create

DOCTOR’S

BAG DR. KATHRYN REITZ Centura Health Physician Group Clement Park Family Medicine 6901 S. Pierce St., Suite 110 Littleton, CO 80128 303-932-2121

Dr. Kathryn Reitz

Kathryn Reitz, DO, believes in the power of physical activity, as it can do wonders for

keeping you healthy and feeling young well into your golden years. And she practices what she preaches. “After I completed my residency at St. Anthony Hospital North (a Centura Health hospital) in 2014, I took some time off to travel,” she says. “I did a six-week walk in Spain called the Camino de Santiago de Compostela. It was quite an adventure.” Reitz’s journey wasn’t without risks, but she realized great rewards, too. “I developed tendinitis in my left ankle at one point, but it was brief. Getting used to carrying all of your supplies on your back was also a challenge, but you get pretty used to it,” she says. “It didn’t take more than a week and a half to feel your own strength. The people I was with — myself included — felt healthier, happier, and stronger toward the end.” Reitz enjoys treating patients of all ages and has a particular interest in sports and exercise medicine.

Should I or shouldn’t I?

Need to know whether or not it’s OK to exercise under these conditions? Here’s a handy guide. CONDITION

OK TO EXERCISE?

NOTES

Pregnant

Almost always

Unless your doctor tells you otherwise, exercise away throughout your pregnancy! It will help prepare you for labor. Just don’t do any activities with a high likelihood of falling, like single’s tennis or skiing.

Injured

Depends on the injury

“Most of the time, physical therapy and continued activity is part of recovery,” Reitz says. “But get it cleared with your physician first.”

Sick

Depends on the sickness

“If it’s just a light cold, you can definitely continue to exercise,” Reitz says. But if you have a fever or more severe symptoms, stay home and rest.

Fatigued

Yes

“Exercise is actually a great way to combat fatigue,” she says. “However, if you’re concerned about what’s causing your fatigue, see your doctor.”

Arthritis

Yes

“Keeping the joint moving is one of the best therapies,” Reitz says. “If you stop using it, you won’t be able to use it in the future.”

1.5%

Adults need at least 150 minutes of moderateintensity exercise each week, according to Centers for Disease Control and Prevention guidelines. That may sound like a lot but if you do the math, it’s really only 1.5 percent of your time. And it’s oh so beneficial to your health and wellbeing. “Being physically active is one of the best things you can do for your health, especially in the elderly,” Reitz says. “It helps prevent everything from chronic disease to falls and fractures. It promotes independence for longer. I would much rather prescribe physical activity now than medications later.”

COVER PHOTO: ©ISTOCKPHOTO.COM/TETMC;THIS PAGE CLOCKWISE: ©ELLEN JASKOL, ©ISTOCKPHOTO.COM/LAFLOR, /DEEAF; OPPOSTIE PAGE: ©ISTOCKPHOTO.COM/LOOPS7, /ANNEBAEK

Activity is the fourth guiding principle of CREATION Health, an Adventist wellness program supported by medical research and promoted by Littleton Adventist Hospital. To learn more, go to southdenver creationhealth. org.

Activity

Behind

the Screens HEALTH SCREENINGS ARE VITAL TO YOUR WELL-BEING. LEARN THE LATEST RECOMMENDATIONS ON THREE OF THE MOST IMPORTANT ONES.

g et ! d e k c e h c I

t can be hard to stay on top of health screenings and changing recommendations on who should get what screenings when. Add into the mix your personal and family history and things get even more complicated. The best bet is to talk with your family physician. Here are the latest changes to three common health screenings that you should put on your list to discuss.

FOR WOMEN

FOR MEN

FOR BOTH

CERVICAL CANCER Women used to have to get a Pap test every Dr. Glenn Bigsby year to check for cervical cancer. But testing has evolved, and women who have received a normal Pap result can now go three years between tests. “The new tests check for HPV, which is the cause of 100 percent of cervical cancers,” says Glenn Bigsby, DO, a gynecologic oncologist at Littleton Adventist Hospital. “After 30, women who are HPV negative can be tested every three years instead of annually.” Screening should begin within a year of becoming sexually active or by age 21. And whether you’re on the threeyear screening schedule or not, it’s still important to visit your gynecologist every year. “We still recommend annual checkups, even if the HPV test isn’t done,” Bigsby says. “There are a lot of other things that women should come in for on an annual basis.”

PROSTATE CANCER Recently, the U.S. Preventive Services Task Dr. James Fagelson Force (USPSTF) recommended against screening for prostate cancer using the prostate-specific antigen (PSA) test that’s been in use since the early 1990s. But urologists and oncologists across the U.S. believe that’s a mistake. “The Task Force based their recommendations on flawed studies that didn’t include men who are at the greatest risk for prostate cancer,” says James Fagelson, MD, a urologist at Littleton Adventist Hospital. “Clearly the death rate from prostate cancer has dropped precipitously since screening began. If people follow the new recommendations by the Task Force, we’re going to see more advanced cancers than we’ve seen in 20 years.” The American Cancer Society and the American Urological Association still favor PSA screening, which is a simple blood test. The ACS urges men to discuss with their physicians a personalized screening schedule beginning at age 40 for highrisk patients and 50 for men at average risk.

LUNG CANCER Lung cancer screening has been around a Dr. Karng Log few years, but only recently have insurance companies started to cover it for high-risk patients. The USPSTF recommends an annual screening for current and former high-risk smokers between the ages of 55 and 80. Patients are considered high risk if they have a total history of 30 “pack years,” meaning they smoked a pack a day for 30 years or two packs a day for 15 years, etc. The screening is simple — it’s a noninvasive, low-dose CT scan. “Lung cancer is, by far, one of the most preventable types of cancer,” says Karng Log, DO, a hematologist and medical oncologist at Littleton Adventist Hospital. “Of course, the best thing you can do for lung cancer is to quit or never smoke in the first place.”

Littleton Adventist Hospital is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas. create | mylittletonhospital.org | 3

M ak i ng

H e ad l i ne s W

hile breast cancer continues to be the second most common cancer among women (behind skin cancer), the good news is that every year fewer women die from it. In fact, survival rates have been increasing for nearly 20 years, and a woman today has a 93 percent or better chance of surviving breast cancer if found at Stage 2 or earlier. One of the biggest factors behind these improvements is advancements in detection that help find cancer at its earliest stages, even before it has officially become cancer.

(From left) Drs. Jodi Widner, surgeon and codirector of the Breast Care Center at Littleton Adventist Hospital, Lisa Hunsicker, board-certified plastic surgeon, and Radhika Acharya-Leon, board-certified medical oncologist, join forces as part of the breast care team at Littleton Adventist Hospital. 4 | SUMMER 2015 • Create

What is it, and what’s the big controversy? No woman wants to hear the words breast cancer. However, a ductal carcinoma in situ (DCIS) diagnosis can be cause for both confusion and optimism. The lowest stage on the spectrum of breast cancers, DCIS is diagnosed when cells that line the milk ducts are abnormal, resembling cancer cells. “In situ” means “in place,” meaning these cells have not left the milk ducts to invade nearby breast tissue. “It’s a Stage 0 cancer. And when we call it a Stage 0 cancer, we’re basically saying it’s not a cancer,” says Radhika Acharya-Leon, DO, codirector of the Breast Care Center at Littleton Adventist Hospital.

PHOTO: ©ELLEN JASKOL

Understanding DCIS

How common is DCIS? One out of every five breast cancers diagnosed every year is DCIS.

Wait. Is DCIS cancer, or isn’t it? “DCIS is classified as a Stage 0 cancer. Technically, it is a precancerous state,” Acharya-Leon says. “Both terms are common.”

Why are we hearing more about it these days? There is an increase in diagnosis of DCIS, largely because of increased use of screening mammography.

What are the implications of a diagnosis? “DCIS is a highly treatable precancer state with excellent outcomes. The long-term survivorship approaches 96 to 99 percent,” Acharya-Leon says. While there is controversy around overtreating — or even treating — a Stage 0 cancer, Acharya-Leon says DCIS can develop into something more serious. “That’s why we treat it. The real danger is that DCIS can change into an invasive cancer and may alter life expectancy.”

What are the treatment options? Surgical treatments include lumpectomy to remove the affected area (with or without radiation therapy) or mastectomy. Tamoxifen therapy also may be appropriate. “The good news is the patient has time to gather information and explore options,” AcharyaLeon says. “At Littleton [Adventist Hospital], we definitely want to impart that there is not a onesize-fits-all approach. We want to help women weigh the risks and benefits to make their own informed decisions.”

What’s new with DCIS diagnosis and treatment? Littleton Adventist Hospital uses a new test called the Oncotype Dx. “The test looks at genes within the tumor itself and helps stratify the patients who have a higher risk of recurrent invasive cancer,” Acharya-Leon says. This more scientific approach can help physicians and patients decide the best course of treatment.

Diagnosed With DCIS? Ask your physician these questions: 1. What does a DCIS diagnosis mean? 2. How will it impact my quality of life? 3. What are my treatment options, and how do they impact my survival? 4. If I choose to do nothing, what is the natural history of DCIS? 5. How do you feel about me getting a second opinion? Radhika Acharya-Leon, DO, co-director of the Breast Care Center at Littleton Adventist Hospital, supports second opinions if the patient desires. “It’s a double-check for me as a physician. If your physician doesn’t like the idea of a second opinion, you’re probably with the wrong physician,” she says. “For a patient, a second opinion can help lead to a decision that’s right for you. There are some cases that are black and white. Other times, there is not necessarily a right or wrong.”

Multidisciplinary Clinic The Breast Care Center at Littleton Adventist Hospital offers a multidisciplinary clinic for newly diagnosed breast cancer patients. “Our patients see a medical oncologist, a radiation oncologist, and a surgeon all in the same day. They also get connected with a breast cancer nurse navigator and a genetic counselor,” says Radhika Acharya-Leon, DO, co-director of the Breast Care Center. “Our patients leave with a coordinated plan.” Jodi Widner, MD, FACS, also codirector, adds that this multidisciplinary clinic approach offers major advantages for both parties. “It’s a huge advantage for us to have the patient meet with all three disciplines. And it’s good for the patient and the spouse or caregiver, who can schedule one visit, hear all the same information, and gain some peace of mind.”

Join the expert physicians from the Breast Care Center at Littleton Adventist Hospital on Oct. 8 to learn more about the latest advancements in breast health and breast cancer treatment. See back cover for details.

Breast Care Center at Littleton Adventist Hospital now offering advanced 3-D mammography

Density of breast tissue has long posed a challenge in mammography. This is because dense breast tissue and cancer cells both show up white on films, compared with a fatty breast, where breast tissue appears very dark. “In dense breasts, it’s sort of like looking for a snowball in a blizzard. The density of the tissue makes it very hard for us to find cancer,” says Jodi Widner, MD, FACS, co-director of the Breast Care Center at Littleton Adventist Hospital. Until now. Littleton Adventist Hospital now uses tomosynthesis, also called 3-D mammography, for all screenings — a particular boon for women with dense breasts. Viewed as a breakthrough in mammography, tomosynthesis provides a clearer, more accurate view of dense breasts than digital mammography alone can produce. “With 3-D mammography/tomosynthesis, the computer views the breast in different layers, or ‘slices.’ Instead of one image, it creates multiple layered images that allow the radiologist to see different views,” Widner says. In addition to tomosynthesis, Littleton Adventist Hospital also screens women with dense breasts with whole breast ultrasound. The Breast Care Center also offers breast MRI and stereotactic breast biopsy, a nonsurgical technique used to assess any abnormalities that may be found through screening.

To learn more about the advanced breast cancer screening and treatments at Littleton Adventist Hospital, please visit mylittletonhospital.org/breastcenter. If you need to schedule a screening, you can call 303-738-2767 or text your name to 720-358-5412 and a scheduler will call you back to make an appointment. create | mylittletonhospital.org | 5

PHOTO: ©ISTOCKPHOTO.COM/MONKEYBUSINESSIMAGES

HERE’S A QUICK Q&A THAT EVERY WOMAN SHOULD READ:

DELAY

KNOWING THE SIGNS AND TELLING YOUR DOCTOR ARE THE KEY. THE MOST COMMON SYMPTOMS INCLUDE ABDOMINAL OR PELVIC PAIN, BLOATING, OR IRREGULAR MENSTRUAL BLEEDING, ESPECIALLY AFTER MENOPAUSE.

Gynecologic cancers, including ovarian and uterine, are relatively rare, accounting for less than 3 percent of cancers in women. Still, more than 71,500 women will be Dr. Glenn Bigsby diagnosed this year with gynecologic cancers, according to the Centers for Disease Control and Prevention. Survival rates are very high if the cancer is caught early, says Glenn Bigsby, DO, a gynecologic oncologist at Littleton Adventist Hospital and Parker Adventist Hospital who treats patients from throughout the region, including Castle Rock. “If detected early, at Stage 1, the five-year survival rate is very high for most types,” says Bigsby, one of just 1,200 physicians nationwide who specialize in the diagnosis and treatment of these cancers. The most critical factor is for women to pay attention to their bodies and report any changes to their doctor early, he says. Symptoms include abnormal vaginal bleeding (especially after menopause), pelvic pain or pressure, abdominal or back pain, bloating, itching or burning, and changes in bowel movements. OVARIAN CANCER Women who are diagnosed with ovarian cancer are much more likely to survive today, thanks to advancing treatments. But because there is no screening test that can help diagnose it at an early stage, it is critical for women to pay attention to symptoms, Bigsby says. Cure rates are 70 percent to 90 percent if the cancer is found while still confined to the ovary, according to the American Cancer Society. If it’s not cancer causing your symptoms, it could be something else that can be treated. Conditions such as endometriosis, fibroids, and even irritable bowel syndrome can cause the same symptoms. And if a pelvic mass is found, there are now two blood protein tests that can help rule out cancer without having to undergo surgery.

ENDOMETRIAL CANCER The most common type of gynecologic cancer is uterine cancer that occurs in the lining, or endometrium, of the uterus. This type of cancer, more commonly called endometrial cancer, is increasing along with obesity rates, Bigsby says. Fat tissue creates estrogen, which stimulates the lining of the uterus and spurs the development of cancer, he explains. About 80 percent of endometrial cancers can be cured with a hysterectomy, but it must be diagnosed early before it has spread. The most common symptom is abnormal bleeding.

Littleton Adventist Hospital’s advanced robotic surgery program is supported by Centura Centers for Clinical Innovation, extending advanced health technologies across Colorado and western Kansas. 6 | SUMMER 2015 • Create

Detecting Ovarian Cancer There is no screening test to help catch ovarian cancer early. But three questions can help determine if a woman should be tested for ovarian cancer, according to a study published in the Open Journal of Obstetrics and Gynecology.

1 DO YOU HAVE ABDOMINAL AND/OR PELVIC PAIN?

2 DO YOU FEEL FULL QUICKLY, AND/OR ARE YOU UNABLE TO EAT NORMALLY?

3 HAVE YOU EXPERIENCED ABDOMINAL BLOATING AND/OR INCREASED ABDOMEN SIZE?

Gynecologic conditions, including cancer, are being more effectively treated through robotic-assisted surgery. Using the advanced da Vinci® robot, gynecologic oncologist Dr. Glenn Bigsby can remove even the tiniest cancerous lesions and tumors without injuring organs, arteries, or healthy tissue. Learn more about gynecologic cancers and robotic surgery, or make an appointment with a nurse navigator at 303-738-7787.

DON’T

SURVIVAL RATES FOR WOMEN WITH GYNECOLOGIC CANCERS ARE RISING QUICKLY, THANKS TO EARLIER DETECTION AND IMPROVED TREATMENT.

Targeting Cancer

ADVANCES IN RADIATION ONCOLOGY DELIVER BREAKTHROUGH TECHNOLOGY CLOSE TO HOME Less is more. We hear this phrase all the time, but it rings especially true in the world of radiation oncology where, thanks to advancing technologies, patients are getting more targeted treatments in less time. “Getting patients through shorter courses of Dr. Darlene Bugoci treatments and back to normalcy — that’s the goal,” says Darlene Bugoci, MD, medical director of radiation oncology at Littleton Adventist Hospital. Here are some of the latest technologies and treatments that Littleton Adventist Hospital will provide patients in its new Radiation Oncology Center, opening in October 2015.

IORT This is an acronym for intraoperative radiation therapy, which can replace — yes, replace — the standard four to seven weeks of Monday through Friday radiation therapy in carefully selected breast cancer patients. Patients with small, early stage cancers are the ideal candidates for IORT, which can be given in a single, 20- to 30-minute, highly targeted dose during a lumpectomy, or in a separate procedure if a patient already has had a lumpectomy. Bugoci characterizes IORT as a breakthrough in convenience and technology for breast cancer patients who otherwise would have to commute five days a week for 10-minute radiation treatments. “They end up spending more time driving to get treatment than they actually spend getting treatment,” she says, noting that Littleton Adventist Hospital has the only Zeiss INTRABEAM® IORT in the region. “Our machine is the only machine that has years of data behind it,” Bugoci says.

From advanced diagnostics to genetic counseling to support groups, learn more about Littleton Adventist Hospital’s range of cancer care services at mylittletonhospital.org/cancer-care.

VARIAN TRUEBEAM™ Anticipated for fall installation at Littleton Adventist Hospital, the Varian TrueBeam system is built to deliver powerful cancer treatments with pinpoint accuracy and precision. TrueBeam can treat all types of cancer, including lung, abdomen, breast, and head and neck cancers. “This is a head-to-toe machine. It can be very precise if we need to treat a specific area,” Bugoci says, noting that the TrueBeam also can be used to perform stereotactic radiation therapy in days rather than weeks. Other hallmarks of the TrueBeam include: • Vision RT — Likening Vision RT to a surface mapping program, Bugoci says this 3-D imaging program helps avoid the use of X-rays to position patients for treatment. • Respiratory Gating — Respiratory gating is a built-in imaging system that helps track the tumor during treatment as natural shifts occur, such as during breathing, Bugoci says. “Using this technology, we can create a smaller field of radiation and still feel confident.” That means hitting the cancer but sparing healthy tissue. Bugoci says it is an exciting time for radiation oncology at Littleton Adventist Hospital. “We are looking at faster treatment times, reduced radiation and X-ray exposure, and highly targeted doses that allow patients to heal faster and return to everyday activities,” she says.

Littleton Adventist Hospital is part of the Centura Health Cancer Network, delivering integrated, advanced cancer care across Colorado and western Kansas.

create | mylittletonhospital.org | 7

Portercare Adventist Health System

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DENVER, CO PERMIT NO. 4773

7700 S. Broadway Littleton, CO 80122

MULTIPLE SCLEROSIS 101

Dr. Julie Seibert will discuss the signs and symptoms of multiple sclerosis and the latest treatment options.

Date | Thu, Aug 6 Time | 6-7 p.m. Location | Littleton Adventist Hospital, Conference Room 1 Registration | mylittletonhospital.org/ lahclasses

2015 CALENDAR

EPILEPSY

Join Dr. Rotem Elgavish to learn 21st century diagnosis and treatment options for epilepsy.

Date | Wed, Aug 12 Time | 6-7 p.m. Location | Littleton Adventist Hospital, Conference Room 1 Registration | mylittletonhospital.org/ lahclasses

LIVING WELL WITH PARKINSON’S DISEASE

Join Dr. Mihaela Alexander, neurologist, as she shares how you and caregivers can live well with Parkinson’s disease.

Date | Wed, Sep 16 Time | 6-7:30 p.m. Location | Littleton Adventist Hospital, Conference Room 1 Registration | mylittletonhospital.org/ lahclasses

THE MANY FACES OF BREAST HEALTH

Dr. Radhika AcharyaLeon, Dr. Jodi Widner, Dr. Lisa Hunsicker, and other breast care experts will speak on oncoplasty, nutrition, screenings, and the latest advancements in breast health and cancer treatment.

Date | Thu, Oct 8 Time | 6-8 p.m. Location | Inn at Hudson Gardens Registration | mylittletonhospital.org/ lahclasses

SUMMER

Littleton Adventist Hospital is part of Centura Health, the region’s leading health care network. Centura Health does not discriminate against any person on the basis of race, color, national origin, disability, age, sex, religion, creed, ancestry, sexual orientation, and marital status in admission, treatment, or participation in its programs, services and activities, or in employment. For further information about this policy, contact Centura Health’s Office of the General Counsel at 303-804-8166. Copyright © Centura Health, 2015.